The Relationship Between Kidney Function and Long-term Graft Survival After Kidney Transplant

Background Whether chronic kidney disease (CKD) staging provides a useful framework for predicting outcomes after kidney transplant is unclear. Study Design Retrospective cohort study. Setting & Participants We used data from the Patient Outcomes in Renal Transplantation (PORT) Study, including 13,671 transplants from 12 centers during 10 years of follow-up. Predictor Estimated glomerular filtration rate (eGFR; in milliliters per minute per 1.73 m2 ) at 12 months posttransplant. Outcomes All-cause graft failure (a composite end point consisting of return to dialysis therapy, pre-emptive retransplant, or death with function), death-censored graft failure, and death with a functioning graft. Measurements The relationship between 12-month eGFR and subsequent graft outcomes through 10 years posttransplant was assessed using Cox proportional hazards analyses. Results Stage 3 included 63% of patients and was subdivided into stages 3a (eGFR, 45-59 mL/min/1.73 m2 ; 34%) and 3b (eGFR, 30-44 mL/min/1.73 m2 ; 29%). Compared with stage 2 (eGFR, 60-89 mL/min/1.73 m2 ; 24%), adjusted Cox proportional HRs for graft failure were 1.12 (95% CI, 1.01-1.24; P = 0.04) for stage 3a, 1.50 (95% CI, 1.35-1.66; P < 0.001) for stage 3b, 2.86 (95% CI, 2.53-3.22; P < 0.001) for stage 4 (eGFR, 15-29 mL/min/1.73 m2 ; 9%), and 13.2 (95% CI, 10.7-16.4; P < 0.001) for stage 5 (eGFR